Monday, February 08, 2010

I Inspire The New Governor Of New Jersey.

I came very close to becoming a breeder, like most of the rest of my college classmates. Far too close for comfort to following the prefabricated path pharmacy graduates were expected to take back in the early 90's, which I can only assume still applies.

1) Buy a new car.

2) Get married.

3) Buy a new house.

4) Pump out the offspring. And cease to live for the rest of your physical existence.

Fortunately there was the bleach incident. Were it not for the bleach incident you might be reading about my little Tyler's basketball game, or perhaps about the unfairness of a school board's decision regarding bus routes. I would be writing to you from my aboveground coffin and you would be bored.

My post-graduation McMansion, however, was located in the middle of nowhere, which meant it got its water from a well. A brand new well. My crowd didn't do used houses. Thinking back, I can't recall one member of my old posse that bought themselves a used house. New wells have to be sanitized, which is done by pouring a gallon of bleach down them, running the water in your brand-new house until you smell bleach coming from your brand new pipes, leaving the bleachy water in your pipes overnight, then flushing out the system in the morning. Simple enough. Unless you decide you're thirsty in the middle of the night like I did. I went to get me a drink of water and it wasn't until the feeling of my esophagus being on fire about a minute later that I remembered. My last thoughts would have gone something like this:

Crap, the bleach water.

I remember I'm not supposed to throw up. I think I'm supposed to eat bread or something.

I should call poison contr.....ZZZZZZZzzzzzzzzz...........

And off to sleepyland the king of the McMansion went. Fortunately a painful esophagus for the next week or so was the worst I had to show for my absent-mindedness and preference of sleep to action. It did give me a chance to reflect a bit though, on what I would have left behind if that really would have been the end. I always credited the bleach incident with being the genesis of the process that ended with me making a break for the coast and you being able to read about Mom's who force their children to kill pet hamsters with hammers instead of little Tyler.

The Governor needs to realize that I am a extraordinary individual. Superhuman almost. And that most people in New Jersey are of a weaker constitution than me.

He also should know that had I stayed awake, I, a licensed pharmacist, would have called a poison control center. And if they disappear, we will be reliant on the judgement of emergency room doctors like the one I saw in college who made a man throw up after accidentally ingesting 60 mg of nifedipine two hours ago.

Sixty milligrams of nifedipine is well within the normal adult dose if you're playing along at home, and after two hours, it was already in his bloodstream.

yes, keyrx, it is the height of narcissism to post about an online petition not to eliminate poison control centers in New Jersey.And encouraging people to participate. To save lives.Doesn't get anymore self-absorbed than that.

That's funny, within 3 months of graduating I had the car, house and marriage. Not interested in kids though. Don't want that kind of responsibility, at least not yet. Not to mention, the only person I want to hear screaming is my wife, kids are so damn annoying

Here's the web address for more information about the closing of New Jersey's Poison Control Line http://www.njpies.org/

(Seems to me, with the sardonic humor DM expresses, he really might have wished to have a traditional family at one time, KeyRx, but for the intent and purpose of this writing it worked out to express some irony.)

Anyway. I work north of let's say for the sake of convenience, Colts territory. Despite metropolitan nature of certain areas of the State, it would be utterly ridiculous to depend on all ER docs around here to look up PoisIndex information themselves, and bypass Poison Control on a regular basis.

Someone correct me if I'm wrong. The 1-800-222-1222 number is the same everywhere. It just connects locally to a State Poison Control center in each State. That is this pharmacist's understanding.

I'm hazarding a guess that NJ and WA would have to spend a million dollars (or some high figure amount of money) on a campaign to inform State residents of how to contact Poison Control.

To borrow a phrase from our President and his chief of staff, what kind of 'fucking retard' would drink water loaded with a high concentration of bleach? Couldn't you smell it before you swallowed? Geez...

Also, its interesting how you use the word 'breeder'. Isn't that a a derogetory slur the gay folks used to describe the straight folks? Not that there's anything wrong with that.

Make that, NJ and WA would have to spend an awful lot on an campaign for providing alternative information dissemination about Poison Control centers in their States.

Poison Control Centers have been around for the better part of the last 25 years or so, and the information campaign about new changes would be probably be pretty expensive. ER docs are not the only people that call them.

My story: Once upon a time I worked the night shift washing dishes in a restaurant a block away from my house. My shower was full of mold, so one night I brought home a glass of bleach. I also brought a slice of luscious chocolate cake and a glass of milk to wash it down with. Of course: I bit into the cake, and took a big swig of bleach. Realized what I'd done and spent the next 20 minutes in a panic, trying to wash my mouth out with something. Dr. Bronner's finally did the trick. My teeth were super white for the next week.

You disappoint me. Half truths and utter confusion between opinion and fact, your usual modus operandi, is well short of the socratic method to be sure, but it is above the level of ad hominem attack to which you've stooped here.

Poison Control Center brings of memories of my experience in Maui many years ago. I was in bed screwing my wife when the phone rang. I chose to ignore it but my wife worried that something happened to relatives on the mainland, reached over and answer the phone. I am still in her as she speaks on the phone, then she hands me the phone. It was a doctor. He had a suicidal woman on the table and he was trying to figure out what poison she took. She was babysitting a dentists home where she took some toxic substance. I gave him what information I had and gave him the phone number of the Poison Control Center in Honolulu for more information. I hung up and went back to pumping my wife. The phone rang again. It was the doctor again. He said that I had more information than the Poison Control Center. I took another intermission from my love making. Using my Toxicology reference books we came to the conclusion that she took Phenol. He proceeded with the antidote and I went back to my favorite sport. Before I could reach the Big O the phone rang again. She died.Later an autopsy revealed that our diagnosis was correct but by the time they got her to the doctor the phenol was well on its way.

My friend spent $80K+ to get preggers as she just had to have Bay-Bees. Fast forward a year through a high risk pregnancy, pre-term triples (that are now 1 year olds with special needs), and a husband busily filing for divorce because-he can't cope, wants out and is more than willing to cut the checks just to get the hell out of there.

Yes, hubby is a douche, but we all warned her he was a douche. Baby rabies makes women plow thru every warning light, and drive that train right into a wall.

I don't have information about all States, but I do know about the one where I live, and let me tell you young whippersnapper, that its function is valuable, valued, and like I said, serves a considerable proportion of healthcare providers as well as members of community.

I don't know why the jab at recovering pharmacists. They chose to remain in the profession, and are fortunate to find a job in pharmacy in your State. Here, we have specially-trained pharmacists in emergency management, and drug information resources. By the way, the initial use of N-acetylcysteine in N-apap OD was promoted by the Rocky Mtn Poison Control. Don't suppose, if they'd been just a bunch of unorganized pharmacists fly-by-nighters that it'd have so much oomph its promotion for overall efficiency in preserving liver function of those with depleted glutathionine stores.

I suppose, someone in our financial-strapped area of the country could propose that we close down the PCC and get rid of the staff, to either depend on local pharmacy schools to provide student rotations and residencies, or farm out the patients to the adjacent State PCC

Again, I couldn't guess where you're commenting from, but here in the mid-eastern cornfields, we get the occasional call about inhaling crop-dusters, imbibing windshield wiper juice, and other inadvertent ingestions.

Wow Anonymous at 9:57,the whole "use of N-acetylcysteine PROMOTION" is fascinating. Here in my state we just tell people not to swallow lots of Tylenol in the first place. I suppose you are somehow equating "promoting" to discovering but hey I digress.

I wonder how many times you refer the crop dust inhalers, windshield wiper juice drinkers and other sufferers of cornfield plagues to 911 or the ER. (services that were not being taken away).

Back in the day, NAC was promoted for use by Rocky Mtn Poison Control as THE antidote for nAPAP OD. How many times did you read the dosing protocol and see mention of its development as a dosing regimen with the consultation phone number listed right there in Goodman & Gilman's 7th Ed. (page 645 or something like it)? I'm not saying 'they' developed it, but I'm hoping the person that reads my mind realizes that NOT only do Poison Control Centers provide a reliable and dependable resource to educators and a Girl Scout troup on a winter camp-out at Eklutna Glacier, but that Poison Control Center involvement in Federal government programs provides training for pharmacists, and an impetus for research.

As for referring patients to 911...why would I refer a person to 911 or an ER if I can transfer them to the State Poison Control where they will be provided the most correct information? Having worked with Poison Control, I know a poisoning will be referred or transferred to the closest ER, that's what THEY are trained to do, if necessary! Having worked on a hospital pharmacy job, in which the phone book inadvertently published our number as the ER number, I KNOW what kinds of calls ER gets, and when I worked night shift in hospital, sometimes ER transferred calls to the night pharmacist. Do you think a busy night pharmacist always has all the time in the world to put on the poison control referral service hat? You've got to be kidding if you think the ER docs don't call Poison Control themselves. Seriously.

Poison Control Centers have got to be some sort of model for providing a specific health service.

And, yes, you are right, I haven't had to refer use of pralidoxime for crop dust exposure for some time, nor assisted nephrologist in alcohol drip dosing or had to provide fomepizole or a reminder that thiamine and pyridoxine are co-factors in metabolic elimination, but you can betch ya sweet patootie that the Poison Control Center already knows all about it when I call.

Plus, I don't think it such a far stretch of imagination to think that some of the contrast dye pre-exposure protocols developed for angiographic procedures and those with renal compromise wouldn't generally be available if NAC guidelines hadn't already well-established through promotion of nAPAP OD guidelines by Rocky Mtn Poison Control (and, yes, I'm not too proud to admit my egomaniacal association with their facility. In fact, on a day like today, I'd rather be on powdery slopes, maybe up near Happy Jack or Medicine Bow, instead of dicking it over the value of a Poison Control Center to the ignoramuses in NJ and elsewhere.)

Perfectly capable pharmacists, physicians, nurses, educators, etc. call 1-800-222-1222 as well as advising their patients to call Poison Control Centers for emergency poisoning triage because 911 operators and ER docs call 1-800-222-1222 for assistance. As a hospital pharmacist, frequently, when I call Poison Control, the Center already knows what incident I'm calling about.

Poison Control Centers often serve as training areas for pharmacists, and incidentally perform valuable research functions. Poison Control Centers receive Federal support for unified and coordinated national emergency response.

Many people outside of pharmacy have no idea of lethal doses of acetaminophen, and are not familiar with the large variety of OTC drug products that contain the active ingredient, yet are not labeled 'Tylenol' as such, instead 'aspirin-free' pain reliever, or 'gentle pain relief'. Dosing of acetaminophen for babies under a certain developmental age is based on age then on mg/kg when past a certain hepatic metabolism threshold. Infant drops are more concentrated than liquid preparations used for other age groups.

Not everyone has access to a computer nor can get to the ER quickly in times of emergency, and furthermore might be incapable of looking to a computer for advice on handling possible overdoses, especially when children are involved.

Poison Control Center professionals at 1-800-222-1222 are trained to deal with emergency ingestion of poison or other toxicities in a state-wide region, and often are quite familiar with where the patient might be calling from or other factors related to the incident. Many times the Poison Control Center in a state is located at a major trauma center and capable of coordinating a wide-spread exposure.

"Many people outside of pharmacy have no idea of lethal doses of acetaminophen, and are not familiar with the large variety of OTC drug products that contain the active ingredient, yet are not labeled 'Tylenol' as such, instead 'aspirin-free' pain reliever, or 'gentle pain relief'. Dosing of acetaminophen for babies under a certain developmental age is based on age then on mg/kg when past a certain hepatic metabolism threshold. Infant drops are more concentrated than liquid preparations used for other age groups."

Call 911 if the person is seizing, unconscious, or not breathing. If toxic exposure is suspected, someone will call 1-800-222-1222. Although most of the NJ petitioners listing their occupation were school nurses, EMTs, ER docs call Poison Control, along with parents. Having the phone number available and handy for anyone that cares for children is usually considered part of the healthcare safety net.

State Poison Control Centers provide valuable information, research, and education. Many times they are located in large cities and can facilitate coordination of care.

Goodman & Gilman's 'Pharmacological Basis of Therapeutics' is a standard pharmacy school textbook,and provides unbiased, well-founded, verifiable information whereas Medifacts, F&C etc. are considered summaries, catalogs, not reliable basic references. WebMD is not going to stand up in a court of law as a drug reference, nor is there an internet reference comparable to the services provided by trained Poison Control health care professionals.

For someone at the state budget office to make a decision about canning the Poison Control Center purely on subscription price is shortsighted and compromises public safety.